Healthcare Provider Details

I. General information

NPI: 1710812151
Provider Name (Legal Business Name): SHONDRA B CALDWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 E COLTON AVE
REDLANDS CA
92374-3755
US

IV. Provider business mailing address

22751 EL PRADO APT 7208
RANCHO SANTA MARGARITA CA
92688-3840
US

V. Phone/Fax

Practice location:
  • Phone: 909-748-8801
  • Fax:
Mailing address:
  • Phone: 310-349-9473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: